A disorder of consciousness (DoC) is a common consequence of severe acquired brain injury (ABI) in children. Children may present in coma, unresponsive wakefulness, or a minimally conscious state, and the duration of DoC is strongly linked with long-term recovery. Early, well-designed interventions are important to support emergence to consciousness and improve outcomes.
Music is considered a particularly meaningful stimulus for children because it is familiar, engaging, and closely linked with memory, emotion, and development. Live music therapy may offer additional benefits because the therapist can adjust the music in real time to the child's responses, potentially extending arousal and engagement. Recorded music, however, can be delivered more widely by families or healthcare staff, and may be more scalable. Despite widespread clinical use, especially at The Royal Children's Hospital (RCH) Melbourne, the scientific evidence for music therapy with children in DoC remains limited, and most prior studies have focused on adults.
This parallel mixed-method study has been designed to build robust paediatric-specific evidence through four integrated components:
Within-subject randomised trial (Component 1):
Participants will complete a 10-day data collection period during hospital admission.
On 8 of these days, participants will receive either live music therapy or recorded familiar music, with the order randomised.
Consciousness will be measured before and after each session using a paediatric adaptation of the Simplified Evaluation of Consciousness Disorders (SECONDS).
The objective is to determine whether live therapist-facilitated interventions are more effective than recorded interventions in supporting consciousness recovery.
Multiple baseline case series (Component 2):
On 2 of the 10 days, participants will take part in video-recorded sessions comparing responses during live music, recorded music, and white noise.
Behavioural responses (such as gaze, facial expression, and movement) will be coded to capture subtle and immediate changes that may not last long enough to appear in pre-post measures.
This component provides a mechanistic understanding of how children respond during auditory stimulation.
Six-month follow-up assessment (Component 3):
At 6 months post-injury, participants' level of consciousness will be reassessed in person or via telehealth.
This assessment will test whether early responsiveness to music interventions or behavioural responses during sessions are linked with longer-term recovery.
Parent and caregiver interviews (Component 4):
Parents and caregivers will be invited to take part in semi-structured interviews about their observations and experiences of music therapy during their child's admission.
Data will be analysed thematically to ensure family perspectives are embedded in the design of future clinical interventions.
Expected outcomes:
This study will provide the first controlled paediatric data comparing live and recorded music therapy in DoC. It will show whether live interventions provide unique benefits, whether early responsiveness predicts recovery, and how families experience music therapy during a critical stage of hospitalisation. Results will have immediate clinical translation by guiding how music interventions are best delivered and resourced, potentially supporting faster emergence to consciousness, shorter hospital stays, and improved wellbeing for children and their families.
